Medical Director, Utilization Management

Location: Remote - US based candidates only, no visa sponsorship available

About the role

This role supports clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.

Responsibilities

• Provide leadership direction for provider credentialing processes
• Ensure timely medical decisions, including after-hours consultations as needed
• Lead efforts in Quality Improvement and Care Management to enhance member health outcomes
• Expedited review of medically pressing issues as per Health Plan policies
• Participate in daily utilization management and quality improvement review processes
• Educate network providers on clinical guidelines and quality standards
• Report communicable diseases as required by statute
• Support implementation of Quality Improvement and Care Management Programs
• Engage with external accreditation and certification activities
• Act as the first level physician reviewer for referred cases

Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited school
• Minimum of 5-10 years of clinical experience
• Managed Care experience preferred
• Board certification in Internal Medicine, Family Medicine, Geriatric Medicine, or Emergency Medicine is a plus
• PA Medical License required

Benefits

• Fully remote position
• Opportunity to lead and impact health care quality
• Engagement in continuous professional development and adherence to latest standards
• Collaboration with a broad network of health care providers
• Involvement in meaningful quality improvement initiatives

Pay

$210,000 – $250,000 annually